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HomeMy WebLinkAbout825 PEAR ST - APPLICATIONS - 3/4/201303/04/2013 13:44 19702241211 ROCKY MTN ROOFERS PAGE 01/01 �O`City.Collins of planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning • Demolition (interior non-structural) 0 Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log • beating Unit ❑ Lawn Sprinkler Ll Mobile Home replacement P(Fiooling ❑ Sewer Line ❑ Photo -voltaic n Ventilation C3 Water Heater 0 Water line ❑ Wood/Pollet Stove (must be EPA certified, provide make, model and manufacturer)_ Complete all applicable information on the application. incomplete applications will not be accepted. Application #�. O Date / 3 For office rse any lob Site Address (requfrad) Value of Cottstruction (labor, matermts, profit) 1 f � fY' $ Sao Property Owner Name Address ` 6410(e- City/State Zip (-f/// Phone 0W ( f- F17Z 1 1f A ( 2L s e'4,-R oZo26-3.( i2 Applicant Name Address City/state Zip Phone Contradnr Lic # - 1-V5 Address City/State Tip Phone C1�� sx�r\' 7xi r� l z `j S.Lit� e SO�� 2o4 -1 Z- o Contractor City of Ft Collins Sales Tax # L1 } Are you paying taxes here or by report? 0 Here trust a000unt? )6Yes ji( Report 0 No trx rnrmtty& reVAedby al/axWactrm Are you paying with your is this a residential or commercial pmjecl? to Residential D Commercial If residential, is It: ' M Single Family Detached Q Condu/townhome (singL- Mom'/ mod) 0 Dupli x 0 Muitifamu?y (apartment) d Garage If oommerdai, is it: 0 Bank ❑ Bar O Church [3 HoteUMotel © Medical office 0 Office L l Retail ❑ Restaurant 0 Other (explain) Is this building 50 years of age or more? Cl Yes allo Oyey ym may rrwd m c 7nWt HisftWc Preservation If this is for a demolition permit, what year was the building constructed? Zfprfor m I975, you W11 need an ads as rt to submit wib4 thls applicafi&L DesCrptlon of work � 7 � i � ,0 0 � % OQ � QP p LeeQ ++' *if lawn sprinkler/haddtow preventer. must Est licensed plumber. If first-time NG must list licensed Wijctncian. Subcontractors:tstMewmp3WrAwworG7tYofFtCaVrt &urzse9 0(Arnm-- 'Kt:0 -F— Eledyk an plumber Medrzrical Roofer Other I hereby acknowledge that t have read tW app!Ka t and state that the above information is comptde and correct I agree to comply with all regiaements contained heron and city ordinances and state lays regulating building construction. I lotm that a permit is not valid until it has been paid and issued. Applicant; Name: �77E1L Print r. Sigftattrra y - y--/ 3 —FYU5,7 ktCourl+